Center for Autism and the Developing Brain and Department of Psychiatry, Weill Cornell Medical College, New York Presbyterian Hospital, White Plains, NY 10605, USA.
J Consult Clin Psychol. 2012 Jun;80(3):477-89. doi: 10.1037/a0027214. Epub 2012 Apr 16.
Our objective was to follow toddlers referred for risk of autism, using standardized observational measures administered frequently from age 18 months to age 36 months.
Sixty-five children who were consecutive referrals and 13 children from other research projects were seen approximately every 2 months, from age 18 months to age 36 months, for standardized assessments and clinical judgments by the same examiner and every 6 months by an examiner blind to previous scores.
Thirty children never received an autism spectrum disorder (ASD) diagnosis; 48 children (all referrals) received at least 1 diagnosis of ASD. The best trajectory typology, using Autism Diagnostic Observation Schedule (ADOS) scores, revealed 4 trajectory classes with high probabilities for fit to the most likely class: severe persistent (21%), worsening (21%), improving (19%), and nonspectrum (40%). Classes differed by trajectories in verbal and nonverbal mental ages; never-ever ASD groups differed on Autism Diagnostic Interview-Revised (ADI-R) domain scores and clinician judgments, but improving-worsening trajectory groups did not.
The results replicated the findings from studies of infants whose siblings have autism and infants whose siblings do not have autism, suggesting variability in early trajectories and supporting the need for early identification, regular monitoring, and standardized assessments of young children suspected of having ASD.
我们的目的是通过从 18 个月到 36 个月定期使用标准化观察测量方法对自闭症风险的幼儿进行随访。
65 名连续转诊的儿童和 13 名来自其他研究项目的儿童，在 18 个月至 36 个月期间，由同一位检查者每两个月左右进行一次标准化评估和临床判断，由另一位对之前分数不知情的检查者每六个月进行一次评估。
30 名儿童从未被诊断为自闭症谱系障碍（ASD）；48 名儿童（所有转诊儿童）至少被诊断为 1 种 ASD。使用自闭症诊断观察量表（ADOS）分数，最佳轨迹分类法显示出 4 种具有高度拟合最可能类别的轨迹类别：严重持续型（21%）、恶化型（21%）、改善型（19%）和非谱系型（40%）。各轨迹类别的言语和非言语智力年龄存在差异；从未被诊断为 ASD 的组在自闭症诊断访谈修订版（ADI-R）的各个领域分数和临床医生判断上存在差异，但改善-恶化轨迹组没有差异。
这些结果复制了对自闭症谱系障碍兄弟姐妹的婴儿和没有自闭症谱系障碍兄弟姐妹的婴儿的研究结果，表明早期轨迹存在变异性，并支持对疑似自闭症的幼儿进行早期识别、定期监测和标准化评估的必要性。
